[PHARM] Antidepressants [Segars]

Question 1

ALL antidepressants either are known to be or can be associated with a _____________________

Answer 1

ALL antidepressants either are known to be or can be associated with a WITHDRAWAL SYNDROME

Question 2

What are the symptoms of withdrawal syndrome?

Answer 2

“F-I-N-I-S-H”

F= Flu-like symptoms

I= Insomnia

N= Nausea

I= Imbalance

S= Sensory disturbances

H= Hyperarousal

Question 3

Special indications for ‘Antidepressant’ meds:

Drug for nicotine withdrawal

Answer 3

Nicotine withdrawl = Bupropion

Question 4

Special indications for ‘Antidepressant’ meds:

Drug for enuresis

Answer 4

Enuresis (involuntary urination) = Imipramine

Question 5

Special indications for ‘Antidepressant’ meds:

Drug for Diabetic peripheral neuropathy, Fibromyalgia and Chronic MSK pain

Answer 5

Diabetic peripheral neuropathy, Fibromyalgia and Chronic MSK pain = Duloxetine

Question 6

Special indications for ‘Antidepressant’ meds:

Drug for Stress Incontinence

Answer 6

Stress incontinence = Duloxetine

Question 7

What does SSRI stand for?

Answer 7

Selective Serotonin Reuptake Inhibitor

Question 8

What are the (7) SSRIs?

Answer 8

Fluoxetine

Paroxetine

Sertraline

Citalopram

Escitalopram

Vilazodone

Vortioxetine

Question 9

What should you remember about the SSRIs that start with a “V”?

What are they?

Answer 9

Make a “V” with your fingers, makes a number two. Remember that these drugs have TWO mechanisms of action. In addition to the standard SSRI MOA, they have another!

Vilazodone (also partial agonist on 5-HT1A)

Vortioxetine (also partial agonist on 5-HT1B and full agonist on 5-HT1A and full antagonist on 5-HT1D,3,7)

Question 10

Where do SSRI’s act?

Answer 10

SSRI’s act on the SERT transporter on the presynaptic neuron

Question 11

Why are SSRI’s the first line class of drugs used?

Answer 11

As a class, fewer side effects and risks than other classes (eg TCAs)

Much less impact on histamine, muscarinic and adrenergic receptors

Question 12

What are the common side effects associated with SSRIs?

Answer 12

• CNS (sedation or insomnia)
• Sexual dysfunction
• Weight gain
• ACUTE WITHDRAWAL REACTIONS

Question 13

What are some of the rare side effects of SSRIs?

Answer 13

Serotonin syndrome (sweating, hyperreflexia, shivering, tremors)

Suicidality

Question 14

Which SSRI has the MOST drug-drug interactions?

Answer 14

Fluoxetine

Question 15

Which two SSRI’s have the LEAST number of drug-drug interactions?

Answer 15

Vortioxetine

Escitalopram

Question 16

What does SNRI stand for?

Answer 16

Serotonin and Norepinephrine reuptake inhibitor

Question 17

Where do SNRI’s act?

Answer 17

Question 18

What are the 3 non-efficacy related receptors that are affected with TCA’s?

Answer 18

1. Histamine (H1)
2. Muscarinic (cholinergic)
3. Alpha1 (adrenergic)

Question 19

What are the 3 key TCA system based side effects?

Answer 19

1. Cardiovascular (alpha) : Tachycardia, orthostatic hypotension, dysrhythmias
2. Anticholinergic (muscarinic) : Dry mouth, urinary retention, blurred vision
3. CNS (histamine) : Sedation/fatigue, dizziness/seizures

Question 20

What are the “3 C’s” associated with TCA overdose?

Answer 20

Coma

Cardiotoxicity

Convulsions

Question 21

What does SARA stand for?

Answer 21

Seratonin Adrenergic Receptor Antagonists

Question 22

What are the (3) SARA drugs?

Answer 22

Mirtazapine

Nefazodone

Trazodone

Question 23

Where do SARAs act?

Answer 23

Question 24

What are the side effects of SARAs?

Answer 24

CNS (sedation)

Orthostatic hypotension

Weight gain

Question 25

What does **NDRI** stand for?

Answer 25

Norepinephrine and Dopamine Reuptake inhibitor

Question 26

What is the (1) **NDRI?**

Answer 26

Bupropion

Question 27

What is the major side effect of **NDRIs?**

Answer 27

Seizures

Question 28

What does **MAOI** stand for?

Answer 28

Monoamine oxidase inhibitors

Question 29

What are the (4) **MAOIs?**

Answer 29

Isocarboxazid Phenelzine Selegiline Tranylcypromine

Question 30

Where do MAOIs act?

Answer 30

Question 31

What is the one **selective MAOI?**

Answer 31

Selegiline (Starts with an **S** for **selective)**

Question 32

What are the side effects of MAOIs?

Answer 32

**Orthostatic hypotension** Sexual dysfunction Weight gain Insomnia/agitation/nervousness

Question 33

Why do most physicians choose not to use MAOIs?

Answer 33

There is a **2 week wash out period,** where you need to remove the previous anti-depressant in order to add MAOIs

Question 34

What is the MAJOR concern when using MAOIs?

Answer 34

Hypertensive crisis (has to do with over ingestion of **tyramine** in diet)

Question 35

What are the symptoms/signs of a **hypertensive crisis?**

Answer 35

Severe headache N/V Sweating/severe anxiety Nosebleeds Tachycardia Chest pain Changes in vision Shortness of breath Confusion

Question 36

What are the two **miscellaneous** agents?

Answer 36

Esketamine Brexanolone

Question 37

What is the MOA of **esketamine?**

Answer 37

NMDA receptor antagonist

Question 38

What is **esketamine** indicated for?

Answer 38

Treatment-resistant depression in conjunction with **ongoing anti-depressant therapy**

Question 39

What is the MOA of **brexanolone?**

Answer 39

GABA(a) receptor positive allosteric modulator

Question 40

What is the indication for **brexanolone?**

Answer 40

Post-partum depression

Question 41

What are the two categories of **mood stabilizer** drugs?

Answer 41

Anti-seizure agents Miscellaneous

Question 42

What are the (3) **anti-seizure agents** used to treat mood disorders?

Answer 42

Carbamazepine Lamotrigine Divalproex/Valproic acid

Question 43

What is the (1) miscellaneous **mood stabilizer** drug?

Answer 43

Lithium

Question 44

What are the top 3 actions of **lithium?**

Answer 44

Brain structure Neurotransmitter modulation Intracellular changes

Question 45

How does **lithium** change the brain structures?

Answer 45

Has **neuroprotective/neuroproliferative** effects

Question 46

How does **lithium** affect **neurotransmitter modulation?**

Answer 46

Lithium inhibits **dopamine** neurotransmission

Question 47

MOA of **lithium?**

Answer 47

A monovalent ion

Question 48

Common system affected by **lithium?**

Answer 48

RENAL

Question 49

What is the major CYP40 inducer?

Answer 49

Carbamazepine